Medication
costs infrequently addressed by physicians
Newswise — A new UCLA
study has found that physicians discuss cost and aspects of
obtaining newly prescribed medications only about one-third of the
time during patient/doctor interactions.
But questions about
pricing and prescription drug insurance coverage are
critical — the high costs of drugs, including out-of-pocket
payouts such as co-payments, are linked to patient
non-adherence in maintaining their dosage schedules, said
Dr. Derjung Tarn, assistant professor of family medicine at
the David Geffen School of Medicine at UCLA and the study’s
lead author.
The study will appear in
the November issue of The American Journal of Managed Care.
“Though cost discussions
are not always necessary, especially if physicians know a patient's
financial situation and the best formulary choice for a medication,
physicians must have a high level of awareness about medication cost
and issues impeding acquisition to medication, because these can be
important barriers to patient medication adherence,” Tarn said.
The researchers used a
combination of patient and physician surveys and transcriptions from
audio-taped patient visits at two Sacramento, Calif., healthcare
systems from January to November 1999. They included a total of 185
patients on outpatient visits with 15 family physicians, 18
internists and 11 cardiologists. Some 243 new medications were
prescribed during these sessions.
Of the 185 patients, who
had a mean age of 55 years, half were male, 83 percent were white,
most had health insurance and more than three-fourths paid less than
half of their prescription drug costs out-of-pocket. Family
physicians saw 31 percent of the patients, internists examined 47
percent, and cardiologists advised 23 percent.
The researchers found that
in only 33 percent of the cases did physicians prescribing new
medications communicate about issues related to medication
acquisition such as cost, insurance, generic or brand name,
logistics, supply and refills. Costs and insurance were covered 12
percent of the time, the logistics of obtaining medications 18
percent of the time, and medication supply
9 percent of the time. Patients initiated discussions about costs or
insurance in only 2 percent of the cases.
Discussions about costs
were likelier to take place when the patient earned less than
$20,000 per year compared with patients whose annual income topped
$60,000, the researchers found. Also, family physicians and
internists were less likely than cardiologists to discuss costs, and
physicians in general brought up the issue less when prescribing
medications to older patients.
Other researchers on this
study in addition to Tarn are John Heritage, Ron. D. Hays and Neil
Wenger, all of UCLA; and Debora A. Paterniti and Richard L. Kravitz
of UC Davis.
The Robert Wood Johnson
Foundation, the UCLA Specialty Training and Advanced Research (STAR)
Program, the Health Resources Services Administration, the UCLA/DREW
Project EXPORT, the National Institutes of Health, the National
Center on Minority Health & Health Disparities, the UCLA Center for
Health Improvement in Minority Elders/Resource Centers for Minority
Aging Research, the National Institute on Aging and the National
Institute of Mental Health funded this study.
